Department of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany.
Department of Preclinical Imaging and Radiopharmacy, University of Tübingen, Röntgenweg 13, 72076, Tübingen, Germany.
Mol Imaging Biol. 2021 Oct;23(5):787-795. doi: 10.1007/s11307-021-01604-1. Epub 2021 Apr 23.
Glioblastomas (GB) and solitary brain metastases (BM) are the most common brain tumors in adults. GB and BM may appear similar in conventional magnetic resonance imaging (cMRI). Their management strategies, however, are quite different with significant consequences on clinical outcome. The aim of this study was to evaluate the usefulness of a previously presented physiological MRI approach scoping to obtain quantitative information about microvascular architecture and perfusion, neovascularization activity, and oxygen metabolism to differentiate GB from BM.
Thirty-three consecutive patients with newly diagnosed, untreated, and histopathologically confirmed GB or BM were preoperatively examined with our physiological MRI approach as part of the cMRI protocol.
Physiological MRI biomarker maps revealed several significant differences in the pathophysiology of GB and BM: Central necrosis was more hypoxic in GB than in BM (30 %; P = 0.036), which was associated with higher neovascularization activity (65 %; P = 0.043) and metabolic rate of oxygen (48 %; P = 0.004) in the adjacent contrast-enhancing viable tumor parts of GB. In peritumoral edema, GB infiltration caused neovascularization activity (93 %; P = 0.018) and higher microvascular perfusion (30 %; P = 0.022) associated with higher tissue oxygen tension (33 %; P = 0.020) and lower oxygen extraction from vasculature (32 %; P = 0.040).
Our physiological MRI approach, which requires only 7 min of extra data acquisition time, might be helpful to noninvasively distinguish GB and BM based on pathophysiological differences. However, further studies including more patients are required.
胶质母细胞瘤（GB）和单发脑转移瘤（BM）是成人中最常见的脑肿瘤。GB 和 BM 在常规磁共振成像（cMRI）中可能表现相似。然而，它们的治疗策略却大不相同，对临床结果有重大影响。本研究旨在评估之前提出的一种生理 MRI 方法的效用，该方法旨在获得有关微血管结构和灌注、新生血管活性和氧代谢的定量信息，以区分 GB 和 BM。
33 例新诊断、未经治疗且经组织病理学证实的 GB 或 BM 连续患者在术前接受了我们的生理 MRI 方法检查，作为 cMRI 方案的一部分。
生理 MRI 生物标志物图显示了 GB 和 BM 病理生理学的几个显著差异：中央坏死在 GB 中比在 BM 中更缺氧（30%；P = 0.036），这与相邻增强的活肿瘤部分中更高的新生血管活性（65%；P = 0.043）和氧代谢率（48%；P = 0.004）相关。在肿瘤周围水肿中，GB 浸润导致新生血管活性（93%；P = 0.018）和更高的微血管灌注（30%；P = 0.022），同时伴有更高的组织氧张力（33%；P = 0.020）和更低的血管氧提取（32%；P = 0.040）。
我们的生理 MRI 方法仅需要额外 7 分钟的数据采集时间，可能有助于根据病理生理差异对 GB 和 BM 进行无创区分。然而，需要进一步的包括更多患者的研究。
